1. Nursing Care of Male Patients with Genitourinary Disorders
Chapter 43
Nursing Care of Male Patients with Genitourinary Disorders

2. Prostatitis Etiology Signs and Symptoms Acute Bacterial
Chronic Bacterial
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Asymptomatic Inflammatory Prostatitis
Signs and Symptoms
Pain
Urgency
Frequency
Dysuria
Urine Retention
Fever, Chills
Prevention of prostatitis regular emptying and complete emptying of the bladder to prevent infection; avoid excess consumption of alcohol because it irritates the bladder; avoid high risk sexual practices i.e. multiple partners.
All symptoms are acute and need nursing attention, however crisis occurs when the patient is unable to urinate, swollen prostate will prevent the bladder from emptying and therefore set it up for further infection and then the infection will be systemic since the urine possibly backs up into the kidneys.

3. Prostatitis

4. Prostatitis (cont’d) Diagnosis Interventions Interventions (cont’d)
Digital Rectal Exam
Urine Culture
EPS
Interventions
Antibiotics
Anti-inflammatory Agents
Interventions (cont’d)
Stool Softeners
Sitz Baths
Prostatic Massage
Avoid Alcohol and Spicy Foods
Surgery

5. Nursing Diagnoses: Prostatitis
Urinary Retention
Risk for Ineffective Self-Health Management
Acute Pain
Anxiety

6. Benign Prostatic Hyperplasia (BPH)
Increase in Number of Cells
Signs and Symptoms
Urinary Retention
Dribbling
Nocturia
Dysuria
Urgency
Diagnosis
DRE
BUN, Creatinine
PSA
Urodynamic Flow Studies
Transrectal Ultrasound
Cystoscopy
Some emergency situations occur with these patients not having urinated in many hours. First thing to do is to insert a foley ASAP and get the bladder drained. At times this requires the physician to use “sounds” which are steel rods in sequential size that are introduced into the urethra through the prostate bed into the bladder, the sizes increase incrementally until the catheter can be passed.

7. Enlarged Prostate

8. Therapeutic Interventions
Symptom Control
Catheterization
Fluids
Antibiotics
Intervention
Watchful Waiting
Alpha-Adrenergic Antagonists
Hormone Blockers
TUMT, TUNA
Surgery
Watchful waiting is where the patient is followed closely by the practitioner assessing for increasing symptoms that the urethra is becoming constricted. So catheter may be used to drain the bladder and to hold the urethra open. Oral fluids to keep bladder flushed out. ATBX to prevent infection.
Alpha blockers may be used as well these relax smooth muscle of the prostate and the bladder neck they block male hormone to prevent tissue growth or to shrink tissue growth, one issue with these is they affect blood pressure and therefore pt is at risk for negative SE r/t hypotension.
TUMT is transurethral microwave therapy applies heat directly to the area to prevent growth.
TUNA is transurethral needle ablation uses radio waves to destroy part of the gland.

9. Transurethral Resection of the Prostate
Resectoscope into Urethra
Overgrown Tissue Chipped Away

10. Transurethral Resection of the Prostate (TURP)
Following the TURP a foley is left in place with a mL balloon this offers pressure of a tamponade in the prostate area to assist with stopping the bleeding. Irrigation solution flows continuously to maintain the patency of the catheter and removes any clots or chips of prostate not evacuated at the end of the procedure. Foley is removed when there is no longer danger of a hemorrhage.
The removal of the prostate does not cause impotency but may cause erectile dysfunction which can be equated with impotency by the patient. Semen is still produced however it may be decreased and it may not be able to be ejaculated fully or possibly no ejaculate.

11. Prostate Cancer Most common cancer in American Men
Usually over 65 years of age
Rare in men under 40 years of age
Risk Factors
African American (highest rates)
American Indian and Alaskan (lowest rates)
Occupational exposure to cadmium

12. Prostate Cancer Signs and Symptoms Rarely occur early stages
Latent stages symptoms
Urinary obstruction
Hematuria
Urinary retention
Advanced metastatic stages:
pain in the back or hip
anemia
weakness
weight loss
overall fatigue

13. Prostate Cancer Complications Bladder problems Difficulty urinating
Bladder or kidney infections
Erectile Dysfunction
Bone fractures
Depression
Eventual death if treatment is unsuccessful

14. Prostatectomy

15. Postoperative Nursing Diagnoses
Risk Bleeding
Monitor Urine Output and Bleeding
Encourage Fluids
Teach Patient to Avoid
Constipation
Lifting
Aspirin and NSAIDS

16. Acute Pain: Bladder Spasm
Monitor Pain
Irrigate Catheter as Ordered
Administer Analgesics, Antispasmodics
Teach Relaxation and Deep Breathing

17. Urge Urinary Incontinence
Teach Kegel Exercises
Offer Condom Catheter or Pads
Encourage to Continue Fluids
Discuss Prolonged Incontinence with Physician

18. Risk for Ineffective Self-Health Management
Teach to Avoid (About 6 Weeks)
Heavy Lifting
Stairs
Driving
Strenuous Exercise
Straining
Sexual Activity
Aspirin and NSAIDS

19. PENILE DISORDERS Peyronie’s Disease Priapism Phimosis
Curved or crooked look to penis
Priapism
Painful erection lasting longer than 4 hours.
Phimosis
Foreskin is retracted and unable to be pulled back over head of penis.

20. TESTICULAR DISORDERS Cryptorchidism Hydrocele Varicocele Epididymitis
Undescended testicle (in infancy)
Hydrocele
Fluid collected in scrotal sac
Varicocele
Varicose veins of the scrotum
Epididymitis
Inflammation of the epididymitis
Orchitis
Inflammation or infection of the testicle
Undescended testicle is a congenital condition usually will drop down in 1-2 months from birth. If not by age 2 surgically brought down. If not reduces his potential for conceiving a child.
Hydrocele usually not dangerous, no tx it is eventually reabsorbed unless it causes discomfort, embarrassment, or threat to the blood supply to the testicles, If treated it can be aspirated, or surgically drained.
Varicocele may feel like a bag of worms pt may report pulling sensation or dull ache or scrotal ache. Usually occurs on the left testicle r/t the way the scrotal vein enters from the left renal vein. Not usually discovered until searching for fertility issues. Can be surgically repaired.
Epididymitis is where the sperms mature before ejaculation. Infection or inflammation can be caused by bacteria, viruses, parasites, chemicals or trauma. R/F include sexual or nonsexual contact, STD, complication of a urological procedure, or reflux of the urine. May be seen with prostate infections. Usually painful the skin is tender, red and warm to touch. Treated with atbx to pt and partner, may require bedrest, elevation of the scrotal sac, ice packs, analgesics. Some symptoms subside in a week, but swelling may last for weeks. Can become chronic can cause an abcess to form and lead to sterility.
Orchitis caused by trauma or infection, epididymitis, a UTI, STD or systemic disease like flu, Mono, TB, gout, Pneumonia, Mumps (after puberty) Swollen tender testicles, red scrotal sac, fever. Interventions same as for epididymitis.

21. TESTICULAR CANCER
Most common cancer in men years of age in the US.
Cause is unknown
Risk Factors are:
Cryptorchidism,
Family History
White ethnicity
High socioeconomic status.

22. TESTICULAR CANCER
Early detection is the best prevention.
Signs and Symptoms
Early warning signs: small, usually painless. Lump on the side or front of the testicle.
Swollen scrotum and feels heavy
Latent symptoms: back pain, shortness of breath, difficulty swallowing, breast enlargement, changes in vision or mental status changes (indicative of metastasis)

23. TESTICULAR CANCER Staging of testicular tumors
Stage I only in 1 testicle
Stage II tumor spread to abdominal LN
Stage III tumor spread past LN usually to:
Lungs, Liver, Bones and/or Brain

24. TESTICULAR CANCER Treatment based on the stage
First complete removal of the cancerous testicle, spermatic cord, and local LN
Radiation or Chemo be necessary depending on the stage
If found early!! Complete recovery is expected.
Require continued follow up and regular testing.

25. TESTICULAR CANCER Nursing care: first is prevention
Teaching young men TSE and to seek treatment at the first changes noted.
If diagnosed, teach about banking sperm for future off spring after treatment.
Help with expression of feelings and prognosis.
Assist with dealing with pain and side effects of treatment